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Detection of Hepatitis C Virus Infection in Patients Undergoing Open Heart Surgery in Childhood Prior to 1992: A
Amalie Rosendahl1,2, Louise Margrethe Kiær Uth3, Nina Weis2,4
1Department of Anaesthesiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.
Insights
A Danish study screened patients who had pediatric heart surgery before 1992 for hepatitis C virus (HCV). The prevalence of chronic HCV infection was 0.8%, with both patients successfully treated using direct-acting antivirals.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Pediatric cardiac surgery patients in Denmark before 1992 received blood transfusions potentially exposing them to hepatitis C virus (HCV).
- HCV screening of blood donors began in 1991, but patients who received non-screened blood may have undetected infections.
- No systematic screening was implemented for this at-risk cohort, necessitating targeted investigation.
Purpose of the Study:
- To determine the prevalence of chronic HCV infection among Danish individuals who underwent pediatric cardiac surgery before 1992.
- To offer direct-acting antiviral (DAA) treatment to identified HCV-positive patients.
Main Methods:
- A nationwide cross-sectional study identified 1645 individuals who had pediatric heart surgery before 1992.
- Participants were invited for HCV screening via anti-HCV-antibody and HCV-RNA testing between 2020 and 2023.
- HCV-positive patients were referred for DAA treatment.
Main Results:
- Out of 1645 identified patients, 571 consented and 246 completed screening.
- Two individuals tested positive for chronic HCV infection, yielding a prevalence of 0.8%.
- Both patients were asymptomatic and successfully cleared the virus with DAA treatment.
Conclusions:
- The 0.8% HCV prevalence in this cohort is higher than the general Danish population but lower than in some international studies.
- Denmark's unpaid blood donation system may contribute to lower HCV transmission risks.
- Targeted screening of at-risk cohorts exposed to pre-1992 transfusions is crucial for HCV detection and treatment, preventing liver complications.
Background And Aim:
Pediatric patients undergoing cardiac surgery prior to 1992 in Denmark were at risk of hepatitis C virus (HCV) infection through donor blood used in extracorporeal circulation. HCV screening became possible in donors in 1991, eliminating the risk of iatrogenic infections. No formalized screening has been conducted for patients receiving non-screened blood, potentially leaving some with undetected HCV infection.
Objectives:
This study aimed to determine the prevalence of chronic HCV infection in this group of patients and offer treatment to those affected.
Design:
Nationwide cross-sectional study.
Methods:
Between 2020 and 2023, 1645 individuals who underwent pediatric heart surgery before 1992 in Denmark were identified. Participants were invited for HCV screening using anti-HCV-antibody and HCV-RNA tests. Patients testing positive for HCV were referred to direct-acting antiviral (DAA) treatment.
Results:
Of 1645 patients identified, 571 consented to participate, and 246 completed HCV screening. Two individuals tested positive for chronic HCV infection, resulting in a prevalence of 0.8%. Both patients were asymptomatic for many years before treatment and successfully cleared the virus after DAA treatment.
Conclusions:
The 0.8% prevalence of HCV in this cohort is higher than in the general Danish population although lower than in similar studies from the U.S. and Germany. This may reflect Denmark's practice of unpaid blood donation, reducing infection risks. Targeted screening for at-risk cohorts exposed to transfusions before 1992 could aid in HCV detection and treatment, potentially preventing long-term liver complications.
Registration:
The study was approved by the Capital Region Ethics Board in Denmark (j.nr. H-18062088).
